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Home My WebLink About862 LOMA CIR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 8s2 LOMA CI Suite: Viciniry: RESIDENCE AND ATTACHED GARAGE Parcel Number: 14133206 npplicant: NGUYEN, CUONG Address: 14351 EUCLID ST SUITE E GARDEN GROVE, CA Owner: CU, DIANE D Address 862 LOMA CIR � , CO6TA MESA, CA Zoning: R1 R1 � � Phone: p14) 545-6994 Zip: 92843 Phone: Zip: 92626 Contractor: VILLA ROOFING PROFESSIONALS INC �Address: 14351 EUCLID ST , , SUITE E " Phone: (714) 545-6994 - GARDEN GROVE, CA , Zip: 92843 License: 756361 Arch : " � .- Eng: Address: �� Address: Status: ISSUED Applied: 07/07/2004 Issued: 07/07/2004 ISSUED BY: � � Phone: � . Phone: Zip: . . License: , . �License: ' ' SCOPE OF PERMIT REROOF RESIDENCE AND ATTACHED GARAGE: T/0 WOOD SHAKE ROOF, FILL IN WITH 1X8 N/00D SHTG, 2 LAYERS 30# FELT, APPLY "EAGLELITE MALIBU TILES"5.5 PSF ICBO#ER-4660 � - - - ' �'" � "' ' • 21SQUARES . � _ �_ _ _,�___FEESUMMARY. Plan Check: $0.00 `- Calc Valuation: Sa,2oo.00 Permit : $16725 Claim Valuation: . _ Ss,zoo.00 SMIP Res: SMIP Com: Other: Inspection: Total: $0.82 $0.00 $0.00 $0.00 $168.07 ,; _ � � PLANNING & ZONING _ � � SETBACKS ��' ;� , > - „ , ' � . �. MAIN STRUCTURE`Front , 0- 0 � . � Rear 0- 0 - � � Left - 0- 0 � . Right -�0- 0 , � �j . ' _. . __ , -- . . . : - / ACCESSORY Front ,0- 0�. - Rear 0- 0, � .- LeR, � 0- 0 � Right 0- 0' PARKING Ezistin : 0 � � �Re uired: o " �� Proaosed: 0. - ,� " � r NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access raquirements under California statutes and related ' regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned I for a period of 1 BO days. . INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspeetlons and final app�oval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. I FOR INSPECTIONS CALL: (714) 7545626 2446d6 (fi/00) WORKERS' COMPENSATION DECLARATION: I hereby ettirm under penalry oi perjury one ol the following tleclarations: ❑ I have flnd will malntain a cenificate ot consent to seli-Insure tor workers' compensation, as pmvitletl tor by sadion 3700 of the Labor Code, for ihe peAormance of the work lor which this parmit Is issued. �� I have and wlll maintain workere' compensation insurence, as requiretl by section 3700 of the Labor Code, for the peAortnance oi the work for which this pertnit is issuetl. My worker�s' com�pen/sation In/�syvance.�\arrier and policy number are: / ,/ Cartier: ei /// /C T�1N1 J Policy Number.�C �%�i �� 7 (This section need nof be compleretl i/ the permit Is velued at one hundred Collars ($100) or less.) ' ❑ I certity that in the peAortnance of Ihe work for whic� this pertnit is issued, I shall not employ any person in any manner so as lo become subject to the workers' compensation laws ot Celifomia, and egree that if I should become suDjact to t�e workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provislons. '/ Applicam SlgnaNre: -+r�^r Date: %/F7 �/7 WAHNINO: F/JLURE TO SECUFE WOS1 Q�AP NS ERAGE IS UNLAWFUL AN� SMALL SU8IECT AN EMPLOVER TO CFIMINAL ENALTIES ND CIVIL FlNES UP TOONE MUNORED THOUSANDDOILARE(51W,000),INADOfiIZJNTOTHECOSTOF OMPENSATION,DAA4IGESASPHOVIDEDFOFINSECilON3lWOFTHELABORCOOE,INTEREST,ANDATTORNEY'SFEES. LICENSED CONTRACTORS DECLAHATION: I hereby ettirm that I em licensed undeyr rovision ot Chapter 9(commencing with Section 7000) ot Division 3 ot the Business and P�of� �Cotle, er�C my license Is in full torce ana ettect. uc. a' �75�3 ��i Class s C" Comreaofs Signature: i�+-e+�J Date: �� CONSTRUC710N LENDING AGENCY: ❑ I hereby attirm that there is a wnsWction lending agency for Ihe peAormance of Ihe work for which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lendefs Adtlress: SlgnaWre: Data: OWNER-BUILDER DECLARATIONS: I hereby alfirm Ihet under penalry of perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reasan (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a pertnit to construct, elter, improve, demolish, or repair any strucWre, prior to Iis issuance, also requires ihe applicant for such pertnit to tlle a si8nad slatement that he or she is Ilcensed pursuent to the provisions of Ihe Gontractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of the Business end ProFeuions Code) or Ihat he or she is exempt therefrom antl the basis for ihe alle9ed exemption. Any violation of Section 7031.5 by any epplicant for e permit sub�ects the epplicant to e civil penalry ot not more ihan five huntlretl tlollars ($500).): ❑ I, as owner of ihe property. or my employees wlth wages as their sole compensation, WILL DO THE WORK, antl the structure is not intendea or oltered tor sale (Sec. 7044, Business entl Professions Coda: The Coniractors License Law does not apply to an owner of property who builds or improves thereon, antl who daes such work himsell or herself or through his or her own employees, provitled that such improvemenis are not intendetl or oHeretl for sale. tl, however, �he building or improvement is sold within one year ot completion, the owner-builtler will hava the burden of proving thet he or she did not builtl or improve for puryose oi saleJ. � ❑ I, es owner of ihe property, am E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the pmject (Sec. 7044, Business and Professlons Code: The contractors Ucense Law tloes not apply to en owner of pmperty who builds or Improves thereon, antl who contracts br such project with a contractor(s) license pursuam m the Contractors License LewsJ. ❑ I em e:empt under sec. Business antl Professions CoOe for this reason: Signature: Date: Owner ID venfied by dnvefs license. ❑ Ves ❑ No Dnvefs License No. Expires: Veritication ot Ownership by (rype ol tlocument, i.e. - properry Wu bill ar deed): DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICATION: ❑ I hereby certiy ihat no excavation five (5) or more feet In depth into which a person is requirad to descend, will6e matle in connection with work auihorized by Ihis pertnit, and that no Duilding siructure, swHoltling, falsework, or demolition or dismantling thareol, will be more ihan thirty-six (36) feet high. (Chap. 32, Gry 2, Ar12, Sec. 341, Ttle 8, Calilomia Administrative Cotla). ❑ As owner-Duiltler, I will not employ enyone to do work which would require a Dermit irom ihe Divlsion of Industriel Sefety, as notetl above, unless such person has e permit to do such work irom the division. SignaW re: Date: Division ot Industnal Safety Pertnit Number. CERTIFlCATE OF COMPLIANCE AND AUTHORVATION OF EMAY: I certity under penalry of perjury that I have reatl ihis epplication and state thai the information given is correct. I agree to wmply wi�h all state lews end city ortlinances relating to building construc�ion, and euthonze represantatives oi ihe Ciry of Costa Mesa to enter upon Ihe ebove-described prop'riior inspectlon pu oses. I egree not to occupy or allow occupency ot eny building authorized by this pertnit until final inspection. �.�/f �gnat re al Ownerjs) � Dat9 / f°�-Co//f Nl/4�f/�G�/ % O7� � An Or Authonzetl Applicanl =�' COUE �. INSPECTIONTYVE 1616 Fixad System Final Fire Prevention 1286 Pool Spe Finel 200 Final Re-Root 201 Flnal BIocWRetelning Well 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition P� 1NtIDel@ '7—��rc,ti �M COUE� INSGECTIONTYGE 206 Final Mechanical 20B Final Plumbinq 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Si�e 250 Final Building/Occupancy GdLF L�,4 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.caB. UILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 862 LOMA CI Suite: Vicinity: Parcel Number: 14133206 Zoning: R1 R1 Applicant: DIANE CU & TODD PORTER Address: 862 LOMA CL . � � CA � - � Phone: COSTA MESA -, - � Zlp: Owner: DIANE CU & TODD PORTER Address 862 LOMA CIR - - � - � - - - Phone: � �COSTA MESA; CA . _ Zlp: 92626 Con[ractor. ' Address: Zip: Arch : Address: 1 Zip: Phone: -- License: Phone: License:. Eng: Address: ISSUED BY: Status: ISSUED Applied: 03/13/2003 Issued: 03/13/2003 Phone: License: SCOPE OF PERMIT INSTALL 6 FT HIGH B�QCK WALL 16 FT LONG (FROM LEFT,SIDE TO DRIVEWAY PAVING) SETBACK 10 FT FROM FRONT PROPERTY LINE. �. _ . _ '_ ' .� ! . _ _ _ FEE SUMMARY _= P1an Check: $1528 , Calc Valuation: S3zo.00 Permik $23.50 --- _ - ----- - - - - -- - Claim Valuation: . . . .80.00 SMIP Res: $0.50 " SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $39.28 SETBACKS , MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existin : o NOTES: PLANNING & ZONING � Rear 0- 0 Left 0- 0 Rear 0- 0 Left 0- 0 Repuired: 0 Proposed: 0 Right 0- 0 Right 0-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 9248, § 1, 12-27-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required Inspeelions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (71q) 7545626 �aas-ae lwoo) WORKERS' COMPENSATION DECLOAATION: , . . � . . � . I hereby affirm untler penalty of perjury one of the following tleclaratians: • � ❑ I have end wlll malntain a cenificate ot consent b setl-Insure tor workers' compensation, as provided for by section 3700 oi ihe Lebor Coda, tor the pedormenca of ihe work for which this permit is issued. ' ' �� ❑ I have en0 will maintain workers' compensation insurence, as requiretl by sectlon 3700 W the Labor Cotle, for Ihe pedortnance of tha w4rk f1or which ihis pertnit is Issued. My workers' compensation Ins ance rpner antl pollcy nu b are: (/V C�JVV V�--� Carrier� �� j Policy Number: (This ection need nat be cromp ed il tb permit is value f one hundred tlollars ($100) or less.) . . I certity that in the peAormance oi ihe wo o ich this pertnit is iss I shall not amploy any person in any manner so as to become suhject to the workars' compen5etion lews of Calitornie, entl egr t�at ii shoultl become �ect to the workers' compensation prohsions oi Sectian�3 700 ot tha��eee bor Cotle, I shall fort�with wmply with these pmvisions. �/ I� 7 /� � Applicent Signeture: Date: � � � l.J WARNINQ: FAIl.URE TO SECURE WORKERS' CO SATIIXJ WVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HIINDRED T/iOUSAND DIXIARE (5100,000�, IN AODRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIQV 3]O60F TME LABOR COOE, ItdrEREST, AND ATiORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: � I hereby eMirm lhet I am licensed under provisions of Chapter 9(commancing wlth Saction 7000) of Division 3 of lhe Business antl Professions Code, end my license is in full �, torce end eReci. Lic. M Cless # � Contrectofs Signewre: Date: �� CONS7RUCTON LENDING AGENCV: ❑ 1 hereby eHirm that there is a construction lentling agency for the Dertormance of the work for which ihis pertnit is issued. (Sea 3097, Civil Code). � Lendefs Name: Lendefs Address: Signature: Date: OWNER•BUILDEii DECLARATIONS: I hereby aHirtn that under Denalry ol perjury thet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or wunry which requires e permit to construct, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires the applicant tor such permit Im file a signed stetement that he or she is Ilcensed pursuant lo Ihe provisions of the Conirecbrs License Law (Chapter 9(commencing with Sectlon 7000) ol Division 3 of t�e Busineu ana Professions Cotle) or that he or she is exempt iherefrom antl ihe basis for ihe elleged exemption. Any violation of Section 7031.5 by eny epplicent for e pertni� sub�ects ihe epplicent m e civil penalry of not more Ihan five hundred dollars ($500).): ❑ I, es owner of the property, or my employees with wa9es as t�eir sole compensation, WILL DO THE WORK, and the strucwre is not intended or oHeretl tor sale (Sec. 7044, Business and Professions Code: The Coniractors License Law does not apply to an owner of propeny who builds or improves Ihereon, and who tloes such work himselt or herselt or �hrough his or her own employees, provided thai such improvemenis ere not intendetl or ottered tor sale. If, however, ihe building or improvement is �old within one yeer of completion, the owneabuilder will heve ihe burden of proving that he or she did not build ar improve for purpose ot sele.). � as owner of the property. am EXCLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS to wnstruct ihe pmject (Sec. 7044, Business antl Profeuions Cotle: The contreciors License Law does not appry to an owner ol properry who builds or Improves ihereon, and who comracts tor such pro�ect with e comractor(s) license pursuant to the Conhectors Licensa Laws.). � I am e:empt untler sec Business end Protessions Code for Ihis reason: SignelurB: � ./iL/w . � Expires: Veriflcation of Ownership by (type of tlocumem, I.e. � property taz bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity iha� no excavation five (5) or more feet in depth into which e person is required to descend, will ba made in connec�ion with work euthorizad by t�is pertnit, and that no building siructure, swNolding, falsework, or demolition or tlismantling thereof, will be more than ihirty-sia (36) faet high. (Chap. 32, Gry 2, Atl 2, Sec. 341, Titla 8, Califomia AdminlslraiNe Cotle). . ❑ As ownerbuilder, I will not employ enyone m do work which would require a permit imm the Division of Indusinal Safery, as noted above, unless such pereon �as e permit to do such work irom the division. Signature: Date: Division of Industrial Sefety Pertnit Number. CERTIFlGATE OF COMPLIANCE AND AU7HORVATON OF EMAY: I cenity under penalty of perjury ihat I have read this application and state that tha infortnation given is correci. I agree to comply with all s�ale laws and city ordinances relating to building construction, antl authonze representa�ives of Ihe Ciry of Costa Mesa lo anter upon Ihe above-describetl property for inspection puryoses. I egree not to occupy or allow occupancy of any building authorizetl y this pe Mit until final inspection. � I ��.1 � Signature Of Legal Owner(s) -� Date An[llOr Authorized Applicant COOE I. INSPECTIONTYPE 1616 FixaO System Final Fire Prevention 1266 Pool Spa Finel . 200 Final Re-Roof 201 Final BIxWRetaining Well 202 Final Factory Fire Place � 203 Flnel Sign Final Demolition QAj$ INfITIRLS Z�-O �c�++li— CO�E� INSPELTIONTYPE � , 206 Final Mechanical 20B Finel Plumbing 210 Finel Elecirical 212 Final Fire Prevention 220 Final Planning Approval ' ' 222 Final Site 250 Final euilding/Owupancy - c i�-y o f co-�-ta� M e�a� WALLS, FENCES, AND LANDSCAPING R-1 ZONE: CITY OF COSTq MESA PLANNING DIVISION � �p SUBJECT TO BLDG. DEPT. REG. Wj ;� �� _ _ _ _ _ NOTE: ADDITIONS,.DELETIONS, �� I � �C�ffR�CTI01tJS SHALL BE 'l ' APPROVED BY THE!PLANNING DI�_ ._ � � J�' ------ � r— --- --- — ��-- — — — -- . ,e�. , •-;�..: i , {' 1: iJ I x , 36' n�pirnum D�1TE: � Q Section A-A j �� wa /fence eig � �� `�J -------�-�-------------- I �' �� -� I g(72 L6N'i0. � i 2C9 �,' � '" : �; 6' high � I i I � �'-` wall/fence line I j 6' high j 36" maximum ,:.�. � � :� f;�� ! � i wall/fence li e a I wall/fence height �.` � Svtsiull! �o' ! ��u 3 I I 3: �� 7 (3l l,� l � i I 1 .*�� CORNER LOT �"' A O� � 35 ft > �k`« ` ' t�` ��"�i^�" `�. ;',� e g4��,�'� 10 ft. ; 1 . _ _ �:� ��.:...�.��:.� �4« .� ,. � . ` <<� ;.;..+., �, . I '+_.Y�:/ . J k... 1'1 5. av�:' - � � 35 ft. � 25' - 27' CURB -�._.-.-._._._._._.-.-._.-.-.-.-._.-.-.-.-.-.-.-._.-.-._.-.-._._._._..� i STREET Height of walls, fences, and landscaping shall conform with Figure 1(on reverse side of this hand out) to allow for visibility at intersections and driveways. NOTE: • Corner/stfeet Cutoffs may be increased or decreased by staff due to Street c� desig n/configuration. Any walls or fences exceeding the specified height limits require discretionary review and • approval. Check with the Building Division for any additional requirements. R2-MD, R2-HD, & R-3 ZONES: Walls, fences, and landscaping shall conform to the standards and specifications for the R-1 zone. Exception: On corner lots, wall and fences in excess of 36" in height shall be set back 5 feet from the street side property line. COMMERCIAL/INDUSTRIAL ZONES: No fence or wall shali obscure the setback landscaping required adjacent to a public right-of-way. i FIGURE 1 � � � ' � � � , . . � �-ik� j �,.:�� :�: � h , � `'•j''� 1 f � • �� i . ; _ _ � , ;' lV� 4 _ _ dc� SECTION A-A zs- zs- �:,. �:. � � �� /� nDOPTID BY FtESOuliION : NO. 01-29 on May 7, 2001 � � L �� } r 1 ' $�� 3 � _ .;z� . ...�CLEAFi FOR �VISBMJTY WALL/FENCE � ��!� r • � � TYPICAL 6�� CONCRETE BLOCK FENCE Cement Coping Optlonal — Channel Bbck With 1�3/8� Hori:ontal Top ot all Fences � For Fences 5' o. Less ' Vert. Bars 3/8"q5 at 4' �0" O.C. , For fences Higher Than 5' Ven. Ban 3/8"� at 32" O.C. � Fill Cells Solid With Grout W here Steel Occurs Rcinlnrcing $teel $hall Cunlorm m Sec.A�15�39 A.S.T.M. All Steel to he Lapped 24" or to Codt NATURALGRADE `;�YQ`i�\��' ��.. c TWO7/8"OBARS - D� CONTINUOUSTOP I � b BOTTOM _�_� 4 HOR1i5TEELMUSTBETIEDIN � VLACE AT TIME OF TRENCN INiVECT10N. p s 0 a x 1� 1- a i > z a I � W O u • Z —KIDTF SEE Cn� BELOw GENERAL- NOTES MOFiTAR; p�e Part Plastic Cemenl, and Three Parts Sond GROUT: One Porl Cement TMee an0 One Holf Parts �ond COPING: One Part Cemenl, Three Ports Sand CONCRETE: Well M�aed 1:2-I/2:3-V2 Mo� of 7-I/2 Goltcns ot Waler Per Sack n( Cement GROUT MAV BE VOURED FROM THE TOP OF 7ME FENCE IN CELlS WHERE STEEL OCCURS. CEllS ANO AREASOi HORIZONTAL REIN fORCEMENT SHAI� BE CLEAR, CLEAN 6 FREE OF ALL MORTAR DEBNIS, ETC. 11 C� C4RTMT(;OTM �/' �nE r+EiGiM OP �ENCE B�IOW BOTTOM OF fOG7iNG �� o" � �� SCALE: 1/2�� = I� FOOTING REQUIREMENTS CHART WIDTH TNICKNESS DEPTH OF EARTHTOOTH SPACING OF EARTHTOOTH 14 I 0'� 2 4" i2' I4 10" 20" 14� BUILDING DIVISION 12' 8" 16" 16' 12„ 8" 12„ 16' �' �ifflS SKEIZt! LS FOR AIFORMAi70NAL PURP066 • SOW WALIS/FIIJCFS BEIWEQJ 2'fi' k 6' IIJ tff1GHT SHALL ONLY. APPLIGNT LS RFSPONSIBLE FOR PROVIDIIJG BE SETBAIX AT LFASC 10' FROM FROM' PROPERTY I.IIJE. AN ACNRATE RFPRESIIdIAl70N OF TF�L2 PROPER7Y IN GSE THE 5}iAPE AND S7TE DO NOT CORRESPOND • SOLID WAILS/}S�NffS SFIALL NOT HX� 2' 6' QJ FIDCFif WffH 7HE INFORMA770N PROVIDED ON 7}fl5 SF�Ef. WID�I IV OF 1}� FROM PROPERIY LNE (N07' CURB IAIE). i� 3 C e � i� � AE9DdCF 1 .'"'""'""' \ �__ • VERIFY DISTAN� FROM CURB TO PROPERIY I1NE AND 4iOW ON PIAN. VERII�7G1iON FROM THE QIYS ENGAIEOiING DIV610N LS RF.QUIR�. GLL (J14) 754,534i AOR INFORMATION. I I � nmoEMCE L 1 S:, ' 1 � 1 I I � I � t s � g� AE90EMIZ NLQIEN� RE90ENCE � i i � i "" !_ MP1_�00(_tAll 4T B�O! J• ""'""""'"'"""'""""_" """'"""_""""""""""� I �_� __ _ _ // STREET BLOCK WALL LAYOUT FOR BUILDING PERMIT PLANNING DIVISION - ��n��: � � � �� EG�EiU�i� CnSTA MESA BUILDING-SAFETY DEPARTMENT DEC 9 1�0 P. O. BOX 3f7 COBTA MEBA. CALIFORNIA �O � o�' �� - rj ��'��+�,E DEPT: � 'Ci,Y OF COSTA MESA For Applieant fo Fill In Completely APPLICATfON FOR P.ERMIT - TYPE OR PRINT gU1LDING BUILDING ADDRES6 COS7A MESA CALIFORNIA For Office Use Only nece�vi rvo. • M!T�NOpa OWNER ��`�!= �.L MA^L . RECE 6D SY D TE R C IVED DATE 188UED .., e«� annn -v r...,e« v�..�......, .. %rev _ I � 7—P'��%_1 n � i1F�` n f1 19�fi 3800 E. C088t �rG NO. OP BIaG/. COSTA MESA. CALIFORNIA APPROVED ' BY ZON¢ I NO. OF R�1 vLANe LE6AL ll% I USE OF � YARDS � EXISTING BLDG. APPROVEO _ S6TBACK LINB FROM / � (CeNTCR LIN6 6TJ ceNiea or eraeer S REAft YARD FRONT SIDE YARD ILEFT I I-RIGHT , R.SIDE DESCRIPTION OF WORK L.SIDE I II I II I � /:. ■ BUILOING �' HEIiEBY Q(LKNOWL AND 6TAT6 SHAT TI PLY WITN ALL CIiY BUILD�NO WN8TRU1 81GNATURE OF PERMI7TEA � AUTHORIZED AGEN ROOF COVE K TO G � UBE OP N BUILDING � THAT 1 HAVB ReAD T B APPLIWTION TXE AMOUNT BHOWN IINDER VALUATION IB pOR TN¢, JVE IS CORRECT AND I1GRE8 TO COM- pUHP08E OR EBTGlLIBHIN4 A PlRMIT FEE ONLY. ik(lCE9 ANO 6TAiE WB REOUL�TIN6 VALUATION ry � ' PERMIT FEE $ .]�O�D N . , .. $ IL�I � SJO. (}D PLAN CHECK S I/• � 0 F p TOTAL FEE Q D LL